<div id="frm_apply" class="row-fluid">
    <div class="box gradient">
        <div class="title">
            <h4><span>APPLY ONLINE FOR VIETNAM VISA</span></h4>
        </div>
        <div class="content">
            <form class="form-vertical" action="<?php echo url_for("apply_online"); ?>" method="post">
            	<input type="hidden" name="func" value="applyForm" />
                <div class="form-row row-fluid">
                    <div class="span6">
                        <div class="form-row">
                            <label for="sbo_number_applicants" class="form-label">Number of applicants</label>
                            <select name="sbo_number_applicants" id="sbo_number_applicants">
                            	<?
								for ($i = 1; $i<= 20; $i++)
								{
									echo '<option value="'.$i.'">'.$i.'</option>';
								}
								?>
                            </select>
                        </div>
                        <div class="form-row">
                            <label for="variable_0" class="form-label">Type of visa and Validity</label>
                            <select name="variable_0" id="variable_0" >
                            	<?php 
								foreach ($formVariables[0] as $formVariable)
								{
									echo '<option value="'.$formVariable['variable_id'].'">'.$formVariable['variable_name'].'</option>';
								}
								?>
                            </select>
                        </div>
                        <div class="form-row">
                            <label for="" class="form-label">Purpose of visa</label>
                            <select name="variable_1" id="variable_1" >
                            	<?php 
								foreach ($formVariables[2] as $formVariable)
								{
									echo '<option value="'.$formVariable['variable_id'].'">'.$formVariable['variable_name'].'</option>';
								}
								?>
                                </select>
                        </div>
                    </div>
                    <div class="span6">
                        <div class="form-row">
                            <label for="variable_2" class="form-label">Processing time:</label>
                            <?php 
							foreach ($formVariables[1] as $formVariable)
							{
							?>
                            	<div class="marginT5">
                                    <input type="radio" name="variable_2" id="var_<?=$formVariable['variable_id']?>" value="<?=$formVariable['variable_id']?>" checked="checked" />
                                    <?=$formVariable['variable_name']?>
                                </div>
                            <?
							}
							?>
                        </div>
                        <div class="form-row">
                            <div class="marginT10">
                                <button type="submit" class="btn btn-large marginT10 btn-warning"><img src="/images/frontend/tick.png" width="32" />Apply Now</button>
                            </div>
                        </div>
                    </div>
                </div>
            </form>
        </div>
    </div>
</div>